Saturday, April 23, 2011

Standard and Poor’s on U.S., Canada, April 18 2011
The brief dust-up over Standard & Poor’s signal of concern over the likely stand-off on the U.S. budget (click on link above) failed to notice the statement’s positive assessment of nations considered the U.S.’ peers. France, the U.K., and Canada all have national, universal health care systems. In particular:
“…Canada, the only sovereign of the peer group to suffer no major financial institution failures requiring direct government assistance during the crisis, enjoys by far the lowest net general government debt of the five peers (we estimate it at 34% of GDP this year), largely because of an unbroken string of balanced-or-better general government budgetary outturns from 1997 through 2008. Canada’s general government deficit never exceeded 4% of GDP during the recent recession, and we believe it will likely return to less than 0.5% of GDP by 2013.”
When they get it right they get it right. But S&P is no bellwether of progressive economics - it still leaves the military budget offline, for example, and while expressing some concern over the extremist Republican agenda of slashing taxes and domestic spending, it mostly fusses that the President may continue to disagree for awhile.
For leadership on the program the public supports and needs – raising taxes on the wealthy and on corporations, protecting and expanding Medicare and Medicaid, and investing in a peacetime economy - look to the Congressional Progressive Caucus, and House Minority Leader Nancy Pelosi.

Saturday, April 16, 2011

The following widely followed column describes every problem in our health care system, problems Medicare shares and perpetuates.

What’s great about Medicare: everyone’s in it and the government runs it.
What’s wrong with Medicare: Fee-for-service payments, no incentives for quality like more primary care and electronic medical records. All improvements that are included in the Affordable Care Act.
Specifically:

Medicare for All Is the Solution

By Robert Reich, Robert Reich’s Blog – 13 April 2011

Mr. President: Why Medicare Isn’t the Problem, It’s the Solution hope when he tells America how he aims to tame future budget deficits the President doesn’t accept conventional Washington wisdom that the biggest problem in the federal budget is Medicare (and its poor cousin Medicaid).

Medicare isn’t the problem. It’s the solution.

The real problem is the soaring costs of health care that lie beneath Medicare. They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.

Americans spend more on health care per person than any other advanced nation and get less for our money. Yearly public and private healthcare spending is $7,538 per person. That’s almost two and a half times the average of other advanced nations.

Yet the typical American lives 77.9 years – less than the average 79.4 years in other advanced nations. And we have the highest rate of infant mortality of all advanced nations.

Medical costs are soaring because our health-care system is totally screwed up.

YES IN MANY WAYS; FINANCING AND DELIVERY SYSTEMS

Doctors and hospitals have every incentive to spend on unnecessary tests, drugs, and procedures.

ALSO TRUE IN MEDICARE. THE ACA SPONSORS DEMONSTRATIONS TO FIX THIS.

You have lower back pain? Almost 95% of such cases are best relieved through physical therapy. But doctors and hospitals routinely do expensive MRI’s, and then refer patients to orthopedic surgeons who often do even more costly surgery. Why? There’s not much money in physical therapy.

ALSO TRUE IN MEDICARE. THE ACA SPONSORS DEMONSTRATIONS TO FIX THIS.

Your diabetes, asthma, or heart condition is acting up? If you go to the hospital, 20 percent of the time you’re back there within a month. You wouldn’t be nearly as likely to return if a nurse visited you at home to make sure you were taking your medications. This is common practice in other advanced countries. So why don’t nurses do home visits to Americans with acute conditions? Hospitals aren’t paid for it.

ALSO TRUE IN MEDICARE. THE ACA SPONSORS DEMONSTRATIONS TO FIX THIS.

America spends $30 billion a year fixing medical errors – the worst rate among advanced countries. Why? Among other reasons because we keep patient records on computers that can’t share the data. Patient records are continuously re-written on pieces of paper, and then re-entered into different computers. That spells error.

ALSO TRUE IN MEDICARE. THE ACA FUNDS AND IMPLEMENTS WIDESPREAD USE OF ELECTRONIC MEDICAL RECORDS.

Meanwhile, administrative costs eat up 15 to 30 percent of all healthcare spending in the United States. That’s twice the rate of most other advanced nations. Where does this money go? Mainly into collecting money: Doctors collect from hospitals and insurers, hospitals collect from insurers, insurers collect from companies or from policy holders.

A major occupational category at most hospitals is “billing clerk.” A third of nursing hours are devoted to documenting what’s happened so insurers have proof.

Trying to slow the rise in Medicare costs doesn’t deal with any of this. It will just limit the amounts seniors can spend, which means less care. As a practical matter it means more political battles, as seniors – whose clout will grow as boomers are added to the ranks – demand the limits be increased. (If you thought the demagoguery over “death panels” was bad, you ain’t seen nothin’ yet.)

Paul Ryan’s plan – to give seniors vouchers they can cash in with private for-profit insurers — would be even worse. It would funnel money into the hands of for-profit insurers, whose administrative costs are far higher than Medicare.

So what’s the answer? For starters, allow anyone at any age to join Medicare. Medicare’s administrative costs are in the range of 3 percent. That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums). And it’s way, way lower than the administrative costs of individual insurance (40 percent). It’s even far below the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.

In addition, allow Medicare – and its poor cousin Medicaid – to use their huge bargaining leverage to negotiate lower rates with hospitals, doctors, and pharmaceutical companies. This would help move health care from a fee-for-the-most-costly-service system into one designed to get the highest-quality outcomes most cheaply.

Estimates of how much would be saved by extending Medicare to cover the entire population range from $58 billion to $400 billion a year. More Americans would get quality health care, and the long-term budget crisis would be sharply reduced. Let me say it again: Medicare isn’t the problem. It’s the solution.

Friday, April 15, 2011

Rick Santorum is one dangerously confused denialist. The former Pennsylvania Senator and presidential aspirant is best known for his inability to associate his professed compassion for life at the level of the zygote, with the physical realities of human sexuality. He has equated loving same-sex relationships to bestiality. He is opposed to abortion under any circumstance. Almost.

In October, 1996, his wife Karen had a second trimester abortion. They don't like to describe it that way. In his 2004 interview with Terry Gross, Santorum characterizes the fetus, who must be treated as an autonomous person, as practically a gunslinging threat, whom the mother must murder in self-defense. Karen has had to justify her decision to save her own life by explaining that if she died her other children would have lost a mother.

Republican extremists in Congress and the statehouses propose to make abortion illegal even if it would save the mother's life. Even the Santorums admit they would make that choice, while claiming that they didn't.

Losing a pregnancy because of a fatal fetal anomaly is never cause for celebration. The pain of second-trimester abortions is compounded by the hateful hypocrites who vilify families facing sorrowful circumstances, and the resulting scarcity of abortion clinicians.

It is revolting that Rick and Karen Santorum choose to stigmatize and harass those of us who, as they did, grieve over the loss of a possible child in the second trimester.

Abortion should not be driving U.S. policy. It's not a more fundamental right than the right to a job or safety from violence. But we can't stop it from being used as a wedge issue if we never talk about our experiences.

Here's the Santorums' description of their second trimester abortion, written by Steve Goldstein,
Philadelphia Inquirer, May 4, 1997

Karen was in her 19th week of pregnancy. Husband and wife were in a suburban Virginia office for a routine sonogram when a radiologist told them that the fetus Karen was carrying had a fatal defect and was going to die.
After consulting with specialists, who offered several options including abortion, the Santorums decided on long-shot intrauterine surgery to correct an obstruction of the urinary tract called posterior urethral valve syndrome.
A few days later, rare ``bladder shunt'' surgery was performed at Pennsylvania Hospital in Philadelphia. The incision in the womb carried a high risk of infection.
Two days later, at home in the Pittsburgh suburb of Verona, Karen Santorum became feverish. Her Philadelphia doctors instructed her to hurry to Pittsburgh's Magee-Women's Hospital, which has a unit specializing in high-risk pregnancies.After examining Karen, who was nearly incoherent with a 105-degree fever, a doctor at Magee led Santorum into the hallway outside her room and said that she had an intrauterine infection and some type of medical intervention was necessary. Unless the source of the infection, the fetus, was removed from Karen's body, she would likely die.
At minimum, the doctor said, Karen had to be given antibiotics intravenously or she might go into septic shock and die.
The Santorums were at a crossroads.
Once they agreed to use antibiotics, they believed they were committing to delivery of the fetus, which they knew would most likely not survive outside the womb.
``The doctors said they were talking about a matter of hours or a day or two before risking sepsis and both of them might die,'' Santorum said. ``Obviously, if it was a choice of whether both Karen and the child are going to die or just the child is going to die, I mean it's a pretty easy call.''
Shivering under heated blankets in Magee's labor and delivery unit as her body tried to reject the source of the infection, Karen felt cramping from early labor.
Santorum agreed to start his wife on intravenous antibiotics ``to buy her some time,'' he said.
The antibiotics brought Karen's fever down. The doctor suggested a drug to accelerate her labor.
``The cramps were labor, and she was going to get into more active labor,'' Santorum said. ``Karen said, `We're not inducing labor, that's an abortion. No way. That isn't going to happen. I don't care what happens.' ''
As her fever subsided, Karen - a former neonatal intensive-care nurse - asked for something to stop the labor. Her doctors refused, Santorum recalled, citing malpractice concerns.
Santorum said her labor proceeded without having to induce an abortion.
Karen, a soft-spoken red-haired 37-year-old, said that ``ultimately'' she would have agreed to intervention for the sake of her other children.
``If the physician came to me and said if we don't deliver your baby in one hour you will be dead, yeah, I would have to do it,'' she said. ``But for me, it was at the very end. I would never make a decision like that until all other means had been thoroughly exhausted.''
The fetus was delivered at 20 weeks, at least a month shy of what most doctors consider viability.
In the months after the birth and death of Gabriel Michael Santorum, rumors began circulating in the Pennsylvania medical community that Karen Santorum had undergone an abortion. Those rumors found their way to The Inquirer, prompting the questions that led to this article.

``There are a lot of people who aren't big fans of Rick Santorum,'' the senator said of the rumors. ``You're a public figure, and you're out there. Maybe it accomplishes a political purpose''...
_____________________________________________________________

see also:

http://www.slate.com/id/1210/ The New Yorker, Jan. 5, 1998

An article chronicles the troubled pregnancy of Karen Santorum, wife of partial-birth-abortion foe Sen. Rick Santorum, R-Pa., and the evolution of the senator's views on the procedure. A birth defect threatened the lives of both fetus and mother, forcing the couple to face the ethical question of whether or not to abort to save her life. Premature labor made the quandary moot--the baby died two hours after birth--but stiffened their resolve against late-term abortion. (A "Strange Bedfellow" bashes Santorum's "pathetic grandstanding.")

Santorum discusses:
Human Life amendment to the constitution,
Why judges opposed to Roe are not activists,
That embryos from fertility clinics should be adopted,
The Catholic mass and viewing with his children at home of his son, Gabriel, who was born 4 months premature and lived for 2 hours .
Listen to entire interview.

http://www.now.org/issues/abortion/alerts/11-13-97.html
Activists urged to call Family Circle on abortion article
November, 1997
--------------------------------------------------------------------------------
Family Circle magazine featured an anti-abortion article in the "Full Circle" section of their October 1997 issue. The article, written by Karen Santorum, decried the use of late-term abortion under any circumstances. And it told the story of her own tragic pregnancy and the decision she and her family made - an option she and her husband would deny to other women .

Karen Santorum is the wife of right-wing, anti-abortion Senator Rick Santorum (R-Pa.). In 1996, Senator Santorum led the debate on a bill that attempted to ban late-term abortions, and refused to make an exception even in the case of "grievous bodily injury" to the woman. In Santorum's article, she expresses her view that carrying a non-viable fetus to term is the only option, and apparently does not think the woman's health or future fertility should be a consideration.

The National Abortion Federation (NAF) responded by requesting that a patient response be printed in the next issue, thus presenting an opposing view and bringing the argument "Full Circle." We have learned from NAF that Family Circle is only planning to publish "Letters to the Editor," and your actions could change their decision. Please urge Family Circle to print the article by Sophie Horak, which was submitted to them by NAF, in its entirety. We do not have permission to send you the text of the original article.

We urge you to email Family Circle at fcfeedback@familycircle.com or call (212-499-2000) and express concern over their incomplete (and in this case, biased) reporting on the very private issue of abortion.
Send letters to:
Family Circle Magazine
___________________________________________________________
http://www.post-gazette.com/books/19980623corner.asp

In his Senate office, on a shelf next to an autographed baseball, Sen. Rick Santorum keeps a framed photo of his son Gabriel Michael, the fourth of his seven children. Named for two archangels, Gabriel Michael was born prematurely, at 20 weeks, on Oct. 11, 1996, and lived two hours outside the womb.

Upon their son's death, Rick and Karen Santorum opted not to bring his body to a funeral home. Instead, they bundled him in a blanket and drove him to Karen's parents' home in Pittsburgh. There, they spent several hours kissing and cuddling Gabriel with his three siblings, ages 6, 4 and 1 1/2. They took photos, sang lullabies in his ear and held a private Mass.

"That's my little guy," Santorum says, pointing to the photo of Gabriel, in which his tiny physique is framed by his father's hand. The senator often speaks of his late son in the present tense. It is a rare instance in which he talks softly.

He and Karen brought Gabriel's body home so their children could "absorb and understand that they had a brother," Santorum says. "We wanted them to see that he was real," not an abstraction, he says. Not a "fetus," either, as Rick and Karen were appalled to see him described -- "a 20-week-old fetus" -- on a hospital form. They changed the form to read "20-week-old baby."

Karen Santorum, a former nurse, wrote letters to her son during and after her pregnancy. She compiled them into a book, "Letters to Gabriel," a collection of prayers, Bible passages and a chronicle of the prenatal complications that led to Gabriel's premature delivery. At one point, her doctor raised the prospect of an abortion, an "option" Karen ridicules. "Letters to Gabriel" also derides "pro-abortion activists" and decries the "infanticide" of "partial-birth abortion," the legality of which Rick Santorum was then debating in the Senate. The book reads, in places, like a call to action.

"When the partial-birth abortion vote comes to the floor of the U.S. Senate for the third time," Karen writes to Gabriel, "your daddy needs to proclaim God's message for life with even more strength and devotion to the cause."

The issue came up again the following spring. Santorum, a Pennsylvania Republican, appeared on the Senate floor with oversize illustrations of fetuses in various stages of delivery. He described the process by which a physician "brutally kills" a child "by thrusting a pair of scissors into the back of its skull and suctioning its brains out." He asked that a 5-year-old girl be admitted to the visitors' gallery, though Senate rules forbid children under 6. "She is very interested in the subject," Santorum said, explaining that the girl's mother had been a candidate for a late-term abortion when doctors advised her during her pregnancy that the child was unlikely to survive.

Sen. Barbara Boxer objected, saying it would be "rather exploitive to have a child present in the gallery" during such a debate. Santorum relented, bemoaning Boxer's objection as proof that "we have coarsened the comity of this place."

The same has been said of Santorum. In so many words, or facial gestures....

Friday, April 8, 2011

The public’s health would be a collateral casualty of caustic ideological battles over the national budget. Republican demands to defund family planning and to stop EPA regulation of greenhouse gas emissions have brought the federal government to a standstill. Crippling the popular Planned Parenthood clinics and lowering air pollution standards would profoundly damage the health of the nation and of California.

Women and men in many of the poorest neighborhoods rely on Planned Parenthood facilities for basic health care services, family planning, HIV care and cancer screenings. The Planned Parenthood Affiliates of California, Inc., has been instrumental in public policy for the health of women and girls.
These ideologically-driven "social riders" to the proposed budget would also eliminate funds for implementation of the Affordable Care Act and the new consumer protection bureau, leaving hundreds of thousands of families struggling to afford medical care.
Cuts could also fall on the Center for Infectious Diseases & Emergency Readiness at the University of California Berkeley, the only research center in the United States on radiological and nuclear public health preparedness.

The proposed $60 billion in cuts that Congressional Republicans have demanded this year, and trillions to come, would devastate the very projects that could revitalize jobs and ensure prosperity. Millions of people’s livelihoods depend on publicly funded transportation, infrastructure, education, and health care.

In addition, the shutdown itself will weaken the fragile economy, immediately placing 800,000 federal workers on furlough, suspending paychecks for soldiers and delaying business loans.
We need to develop a comprehensive solution that revitalizes federal revenues, while requiring those who benefit the most from our society’s infrastructure to pay the most to ensure its upkeep. Taxes for corporations and for wealthy individuals declined over the last decade, resulting in significant income disparities between the rich and the poor in the U.S., and leading to health inequalities. Reversing tax giveaways to the super-rich and the nation's largest corporations could raise $4 trillion within a decade.
We stand in support of reproductive and public health and against the threat of climate change! We urge our federal representatives to insist that these important programs continue!

Yes we have to fix financing. Yes we have to fix the delivery system. It's not a choice. Whichever we do first will not "work" (that is, control costs, and improve health) til we do both. It's understandable that we are having this debate: the Administration has tried to sell the delivery system reforms in the ACA as sufficient cost controls; many mainstream health economists are dubious about this, as are we. But it is also not the case, as Dr. McCanne asserts, that "the single payer model is structured as an altruistic, aspirational system that, quite automatically, actually does, in itself, improve quality and control costs." That's why every single payer bill before Congress also includes delivery sustem reforms, and always did. We need to be ready to fight for these reforms and for equity and accountability, as well as cost control, or we'll be surprised when the elected officials we put in charge of the single payer system cave in to the medical industrial complex. (Read up on Taiwan pre-single payer to get an idea of the relative simplicity and low cost of their system pre-reform. Different universe from the U.S.) Or try to cut funding for family planning.

As a single payer advocate I value the delivery system reforms in the ACA. They will not control costs unless and until we impose a budget on the healthcare system. We need a 900 pound government negotiator saying "no" to the drug, medical supply, institutional care, and provider industries. We can "save" all the money these reforms can achieve and the industry will find another pocket to put it into. (And by the way the ACA does put a cap on the Medicare budget as of 2019; we cd debate about the value of this and the likelihood of it occurring; but can also recognize the value of using the levers we have, including this one.)
But when we get to that point we'll be in better shape to make it work if we understand (as you both do) what we need to do to fix it so that people get care, and what safeguards and incentives we need to have to keep the system accountable. (It helps that Sebelius at HHS and CA's Insurance Commissioner Dave Jones, for example, are modeling what we want our regulators to do.)
Some people will not die in Massachusetts this year who otherwise would have because they have coverage. If they get sick next year, as the system becomes less "affordable" (meaning the state raises co-pays, instead of raising corporate taxes to pay for health care) they may be at greater risk.
We continue to murder people in hospitals through preventable errors in medications and other organizational dysfunctions, to say nothing of antibiotic resistance. This hasn't changed much since "To Err Is Human" came out in the 1990s. Electronic medical records will help address some of these problems. Better nurse staffing ratios will also help (something that nurses continue to fight for while fighting for single payer, because it improves quality and because it gives them more power as workers and professionals; it's a fight we can and must support at the same time as we fight to get rid of the parasitic insurance industry.)
Some teachers in CA took over a Wells Fargo bank in Oakland on Monday and closed it down for 2 hours. http://sanfrancisco.cbslocal.com/2011/04/04/oakland-teachers-ask-wells-fargo-bank-for-bailout/
If people all over the country were taking militant action on a regular basis, things might look a lot different today. Didn't happen. in 2009-10; might happen now.
So. do we go back now and accept that delivery system reforms in themselves, including those in the ACA, will control costs? Nope.
When we talk - and think - about what a single payer system is going to do and how we're going to make it work, why on earth would we abandon talking about delivery system reforms?

The point is not just to make health care cheaper; we could put the whole military budget into CMS and it wd be a vast improvement in our health. The point is to make the health care system equitable, high quality, universal, accountable and affordable. And to rebalance power relationships so that we have more of it (a major determinant of health).